• Sensitive method: Direct • Human pathogen that is transmitted through

microimmunofluorescence aerosol droplets.

• Precautionary measures: Only laboratories • One of the major causes of infectious respiratory
with biosafety level 3 facilities can perform the disease
isolation and cultivation of the specimens • Associated with pneumonia, bronchitis,
CHLAMYDOPHILA PNEUMONIAE pharyngitis and sinusitis.
• Formerly known as the Chlamydia pneumonia • Specimen for isolation: Nasopharyngeal
strain TWAR. aspirates, sputum and throat swabs.
o TWAR – Taiwan Acute Respiratory • Culture media: He LA cells or Hep-2 cell lines
Chlamydia • Preferred method: Microimmunofluorescent
assay.
PROPERTIES C.TRACHOMATIS C. PSITTACI C. PNEUMONIAE
Host range Humans Birds Humans
Elementary body Round Round Pear-shaped
Round, vacuolar
Inclusion morphology and Variable, dense Levinthal-
Halberstaeder-Prowazek Round, dense
inclusion body Cole-Lillie bodies
bodies
Stain used Macchiavello stain and
Lugol’s Iodine Giemsa stain
Giemsa stain
Glycogen-containing
Present Absent Absent
inclusions
Susceptibility to
Sesceptible Resistant Resistant
sulfonamides
Trachoma, LGV and
Disease Psittacosis Pneumonia, Pharyngitis
inclusion conjunctiva
Number of Serovars 20 10 1

COMPARATIVE PROPERTIES OF MICROORGANISMS

• Zoonotic disease acquired by humans through

inhalation of dried excreta of animals or infected
birds.
• Causes: mild flu, lung infection
• Also known as Ornithosis or Chlamydiosis.
LESSON 5: CELL WALL-DEFICIENT &
SPIROCHETES AND MISCELLANEOUS
BACTERIA
CELL WALL DEFICIENT BACTERIA
• Mycoplasma
• Ureaplasma
• Specie: M. pneumoniae, M. hominis, M.
fermentans, M. pirum, M. penetransand U.
PARROT DISEASE urealyticum
• Psittacosis (1929) MYCOPLASMA AND UREAPLASMA
o Ducks, pigeon, hen, sparrow, cockatiels, • Both mollicutes
macaws, budgerigars

TUAZON A. 43
 • Smallest free-living organisms that are capable
of growing in artificial media.
• Pleomorphic organisms that lack cell wall
• They found mainly in the oropharyngeal, upper
respiratory and genitourinary tracts.
• Slow growing, fastidious and facultative
anaerobes that replicate by binary fission.
• Requires sterols (cholesterol) for membrane
function and growth
• Common parasites of the genital tract and their
transmission is related to sexual activity.
• Etiologic agent: Primary atypical pneumonia or
walking pneumonia
• Extremely fastidious
• MOA: Inhalation of contaminated aerosol
droplets
• Initiation of Disease: Attachment to respiratory
mucosal cells, evasion from phagocytosis and
modulation of the immune system.
• Culture: SP4 broth: Yellow color
ATYPICAL PNEUMONIA
• Can occur as separate incidents or as outbreaks
in closed population such as in school, military
camps and within family members.
MYCOPLASMA HOMINIS & UREAPLASMA
UREALYTICUM(GENITAL MOLLICUTES)
• Recovered from the genital tract of healthy
adults.
• Cause prostatitis and pelvic inflammatory
disease.
• Colonization among infants occurs during
passage through an infected birth canal and
results in the isolation of these organisms from
their nose and throat.
• M. hominis: Causative agent of postabortal
fever and postpartum fever in women.
• Culture:
o M. hominis: “Fried-egg” appearance on
plated medium
o U. urealyticum: “dark-brownish lumps”
on a A7 or A8 Agar media.
LABORATORY DIAGNOSIS
• Specimen: Throat swab, serum,
bronchoalveolar lavage, sputum and lung tissue
for M. pneumoniae
• Genital mycoplasma: urethral, vaginal or
endocervical swab, blood, urine, prostatic
secretions and semen.
• No direct method or gram staining can be
used for identification since mycoplasma
and ureaplasma lacks cell wall.
CULTURE:
• Culture media: Beef or Soybean protein with
serum, fresh yeast extract, biphasic SP4
medium, pleuropneumonia-like organism
(PPLO) broth or agar with yeast extract and
horse serum, A8 agar (usually used for
ureaplasma), Shepard’s 10B arginine broth and
modified New York City medium.
• Swab: Calcium alginate and Dacron swabs.
• Transport medium: SP4 (sucrose phosphate
buffer, horse serum and neural red).
• Mycoplasma and Ureaplasma grow slowly
than most of the other bacteria
• M. hominisis the only species that is capable of
growing on BAP and CAP
• M. Pneumoniae requires biphasic culture
system and incubation of up to three weeks in
chamber with 5% to 10% CO2
• Urea and/or arginine: incorporated into the
media to detect the presence of U. urealyticum
and M. hominis and produce alkaline reaction.
• Mycoplasma in Shepard’s 10B arginine
medium: red color. Blood culture: not
recommended
• Serodiagnosis
o ELISA: Most commonly used
serological method for diagnosis of
Mycoplasma and Ureaplasma.
• Manganese Chloride Urea Test
o Rapid identification test for U.
urealyticum
o Reaction for the test is observed under
a dissecting microscope.
o (+) results: dark brown precipitate of
manganese oxide around the colonies.
o U. urealyticum utilizes manganese
chloride in the presence of urea.
• Dienes stain of
Mycoplasma spp. colonies
demonstrating typical fried
egg appearance
• Typical mixed sizes of
Mycoplasma spp. on
primary isolation
media, Mycoplasma
salivarium.
TUAZON A. 44
Clinical Bacteriology (Lecture)
SECOND TERM

DASH
Our Lady of Fatima University – Pampanga
College of Medical Laboratory Science TWO
TWO
SUMMARY OF ASSOCIATION OF GENITAL MOLLICUTES WITH UROGENITAL AND NEWBORN DISEASES
Disease, Target Mycoplasma Mycoplasma
Ureaplasma spp. Comments
Population hominis genitalium
Nongonococcal Ureaplasma spp.
urethritis cause some cases,
None Weak Strong
but the proportion is
unknown
An association with a
few cases of chronic
Prostatitis None Weak None disease has been
reported; a causal
relation is unproven
Epididymitis Mycoplasma spp. are
None None Weak not an important
cause
M. hominis is often
Vaginitis and associated with
None None None
cervicitis disease, but a causal
relation is unproven
Pelvic inflammatory M. hominis causes
disease Strong Strong None some cases, but the
proportion is unknown
Recent studies
indicate that M.
Postpartum fever Strong None Weak
hominis may be a
major cause
Urinary calculi Ureaplasma spp.
cause calculi in male
rats, but no
None None Weak convincing evidence
exists that they cause
natural human
disease
M. hominis causes
Pyelonephritis Strong None None
some cases
Involuntary infertility Ureaplasma spp. are
associated with
Weak None
altered motility of
sperm
An association exists,
Chorioamnionitis Strong None Strong but a causal relation
is unproven
Low birth weight An association exists,
None None Strong but a causal relation
is unproven
Further clarification is
Neonatal infections,
needed, but
including sepsis,
Strong Strong importance is growing
pneumonia,
in a selected prenatal
meningitis
population
Neonatal period, These findings need
particularly preterm further clarification
delivery, very low birth because most
weight; clinical signs Strong Weak Strong neonatal infections
compatible with resolve without
meningitis (CSF), therapy, but in low
pneumonia (trachea), socioeconomic

TUAZON A. 45
sepsis (blood) groups the diagnostic
workup of newborns
should include CSF
and blood cultures for
detection of
mycoplasmas. This
includes low-birth-
weight and preterm
newborns, in whom
traditional CSF cell
counts and cultures
would be negative

• Identification of Mycoplasma-infected cell culture using DNA fluorochrome

stain (Hoechst 33258 stain). A, Mycoplasma orale. B, Uninfected Vero cell culture
highlighting the DNA-rich nucleus. C, Mycoplasma salivarium. The mycoplasma
appear as small, pinpoint, fluorescent bodies throughout the background.

• Mixed isolation of Mycoplasma hominis and Ureaplasma urealyticum showing

why U. urealyticum was originally called “T” for “tiny strain”.

COMPARATIVE FEATURES OF VARIOUS LABORATORY METHODS USED TO DETECT MYCOPLASMA

PNEUMONIAE, MYCOPLASMA HOMINIS, AND UREAPLASMA UREALYTICUM
Detection Method Mycoplasma pneumoniae Mycoplasma hominis Ureaplasma urealyticum
NONSEROLOGIC
Method of choice using
Method of choice, but must
urease detection, but must
Culture Traditionally difficult differentiate infection
differentiate infection from
from colonization
colonization
Indirect Respiratory antigen for
immunofluorescence early-stage infection
Research use only but is
promising
Polymerase chain reaction Assays are being evaluated Assays are being evaluated Assays are being evaluated
SEROLOGIC
Traditional assay but <50%
seroconvert; need fourfold
rise between acute-phase
Complement fixation
and convalescent sera; >32
single titer may be
suggestive
Immunofluorescent Measures IgG and IgM Measures IgG and IgM
antibody separately separately; not
recommended
Latex agglutination IgM/IgG IgG only
Enzyme immunoassay Method of choice
Reactive IgM, IgG, and IgA,
but IgM level may remain
elevated for 1 year

TUAZON A. 46
SPIROCHETES AND MISCELLANEOUS BACTERIA fresh blood, injuries from contaminated needle
• Treponema sticks and handling specimen
• Borrelia • Symptoms: Chancre (hard chancre), fever, sore
• Leptospira throat, headache, rashes (palm and soles) and
• Miscellaneous: Streptobacillus moniliformis, gummas on skin.
Spirillum minus, Klebsiella granulomatis, o Soft chancre: H. ducreyi
Capnocytophaga and Enterococci • Stages of syphilis:
GENERAL CHARACTERISTICS OF o Primary syphilis
SPIROCHETES o Secondary syphilis
o Latent stage
• Belongs to the order
o Tertiary stage or Late stage
Spirochaetales
• Unusual morphologic
PRIMARY SYPHILIS
features • Appearance of hunterian or hard chancre,
• Facultatively anaerobic • Painless, usually seen on the genitalia
or aerobic • Develops 10 to 90 days after infection
• Various types of motility • No systemic signs and symptoms
pattern SECONDARY SYPHILIS
• Have fibrils or axial filaments which are flagella- • Develops 2 to 12 weeks after appearance of
like organelles that wrap around the bacterial chancre
cell wall and facilitate motility (exhibiting a • All lesions that are observed seen in this phase
“corkscrew like” winding) are highly infectious
• General microscopy: slender, helical and • Chancre heals but organisms are still
unicellular bacteria disseminated via blood stream
• Genera: Treponema, Borrelia and Leptospira. • Symptoms: Fever, Sore throat, headache and
TREPONEMA rashes (palms and soles)
• Greek word: Trepein means “to turn” and nema LATENT STAGE
“thread”, “turning thread” • Disease becomes subclinical but not necessarily
• Darkfield microscope dormant
• Infects only human • Occurs within more than a year of infection
• Stain poorly with Gram or Giemsa stains • In this stage, diagnosis can be made only by
• Reproduction: Transverse fission serological test
• Microscopy: Thin, spiral organisms with three TERTIARY STAGE/LATE SYPHILIS
axial filaments. Cell end are pointed and
• Tissue-destructive phase
covered with a sheath.
• Appears 10 to 25 years after initial infection
TREPONEMA PALLIDUM SUBSP. PALLIDUM
• In this stage, individuals are not usually
• Causative agent of syphilis infectious
• Microaerophiles which survives longer in the • Complications: Central nervous disease
presence of 3% to 5% oxygen, (neurosyphilis), cardiovascular abnormalities,
• Killed rapidly at 42C eye disease and granuloma-like lesions
• Remains visible in whole blood or plasma for (gummas)
atleast 24hrs, which is potential importance in LABORATORY DIAGNOSIS
blood transfusion. • Specimen: Skin lesions (cleaned with saline)
• Can cross intact mucous membrane and • Oral lesions: should not be examined because
placenta non-pathogenic spirochetes will lead to false-
• Darkfield microscopy: White against a dark positive results.
background and long with fine spirals that have MICROSCOPIC EXAM
10 to 13 coils and three fibrils/periplasmic
flagella. • Direct examination of exudates is recommended
and motility
• Generationtime:30hours
• Definitive test: Darkfield microscopy
• Diagnostic Test:
o Treponemal reagin • Stain: Levaditi’s stain and Fontana-Tribondeau
o Non-treponemal reagin stains.
SYPHILIS • Direct detection in lesions: FITC (Fluorescein
isothiocyanate-labeled antibody)
• AKA: French disease / Italian disease / The SERODIAGNOSIS (SECONDARY AND
Great Pox
TERTIARY)
• Disease of blood vessels and perivascular areas
• Known as “great imitator” • Non-treponemal Test/Non-Specific Test –
• MOA: sexual contact, congenital transmission, Screening test. Detects the presence of non-
skin contact with active lesion; transfusion of specific antibody or antibody-like protein like

TUAZON A. 47
 your regain or Wassermann antibodies. This is
used to monitor syphilis.
o RPR - Rapid Plasma Reagin
o VDRL - Venereal Disease Research
Laboratory
o USR - Unheated Serum Reagin
o TRUST - Toluidine Red Unheated
Serum Test
o ELISA - Enzyme-Linked Immunosorbent
assay
• Treponemal Test/Specific Test – Confirmatory
test. Usually used to detect the presence of
antibody to the treponemal antigens.
o FTA-ABS - Fluorescent Treponemal
Antibody Absorption
o MHA-TP - Microhemagglutination Assay
for Treponema Pallidum
(Microhemagglutination Test for
Treponema palli- dum)
o TPHA - Treponema Pallidum
Hemagglutination
o TPPA - Treponema Pallidum Particle
Agglutination Assay
MOLECULAR TEST
• PCR used for neurosyphilis detection during
tertiary syphilis
• Western blot detection of congenital syphilis.
TREPONEMA SPP.
TREPONEMA PALLIDUM SUBSP. PERTENUE
• Causative agent of Yaws or frembesia tropica
• Acquired by direct contact through skin breaks
with an infected lesion.
• Non-venereal infection, chronic ulcerative sores
TREPONEMA PALLIDUM SUBSP. ENDEMICUM
• Causative agent of endemic non-venereal
syphilis or Bejel
• Non-venereal syphilis, appearance of primary
lesion near mouth. Pimple-like lesions on trunk,
arms and legs
TREPONEMA CARATEUM
• Causative agent of pinta or carate
• Acquired by contact with infected skin
• Pinta: skin infection characterized with primary
lesions or graduall enlarging papule with
enlargement of regional lymph nodes. (Red to
blue macular rash)
TREPONEMA DENTICOLA & TREPONEMA
SOCRANSKI
• Ulcerative gingivitis and chronic periodontitis.
BORRELIA (BLOOD SPIROCHETES)
• Borrelia recurrentis, Borrelia dutoni, Borrelia
hermsii, Borrelia turicatae, Borrelia parkeri,
Borrelia afzelii, Borrelia burgdorferi (most
commonly encountered, causes lyme disease)
and Borrelia garinii
• B. recurrentis (arrows) in
blood.
GENERAL CHARACTERISTICS OF BORRELIA
• Slow growing sphirochetes that multiply by
binary fission
• Composed of 3 to 10 loose coils and is actively
motile
• Species have 15 to 20 axial filaments and two
insertion disks
• They stain well with Geimsa stain and can be
visualized by using brightfield microscopy.
• Species that have been grown in vitro are
microaerophilic.
BORRELIA SPP.
BORRELIA RECURRENTIS
• Agent of louse-borne/ epidemic/ European
relapsing fever
• Vector: Louse (Pediculus humanus)
• Reservoir: Humans
BORRELIA HERMSII, B. TURICATE, B. DUTONI
AND B. PARKERI
• These agents are tick-borne relapsing fever/
endemic/ American relapsing fever.
• Vector: Soft ticks (Ornithodoros)
BORRELIA BURGDORFERI, B. GARINII AND B.
AFZELII
• Agents of Lyme disease (B. burgdorferi)
• Vector: Hard ticks (Ixodes) – Ixodes pacificus,
Ixodes scapularis (deer tick), Ixodes
persulcatus, Ixodes dammini
• Transmission: Bite of the Ixodes ticks
• Natural hosts of ticks: Deer and Rodents
(Peromyscus leucopus or white-footed mouse)
• All stages of ticks (larval, nymph and adult) can
harbour the organisms and transmit disease
RELATED DISEASES AND LABORATORY
DIAGNOSIS
• Related diseases
RELAPSING FEVER
• It is an acute infectious disease with recurring
febrile episodes (2 to 10 relapses)
• Symptoms: Fever, headache, myalgia (2 to 15
days after infection)
LYME DISEASE
• Acute, recurring inflammatory infection involving
the large joints, like knees.
• Hallmark of infection are erythema migrans
(bull’s eye lesion on the skin) and swelling
LABORATORY DIAGNOSIS
MICROSCOPIC EXAMINATION
• Giemsa and Wright stain
o Darkfield microscopy, Blood culture after
2 to 3 weeks of incubation at 35C.
• Relapsing Fever
o Specimen: Peripheral blood
o Spirochetes in peripheral blood, stained
as blue colored.
• Lyme Disease
o Specimen: Blood, CSF, and Biopsy
specimen
TUAZON A. 48
 o Tissue section: Warthin-Starry stain is o Entry through breaks in the skin,
used. mucous membranes or conjunctiva
CULTURE o Direct contact with the urine of carriers
• Culture media: Barbour-Stoenner-Kelly medium like rats
or Chick embryo o Contact with bodies of water that are
• Organisms are slow-grower and requires 7 to 14 contaminated with the urine of the
days at 35C carriers
o Upon entry, Leptospira rapidly invades
SERODIAGNOSIS
the bloodstream and spread throughout
• Relapsing fever: Serological test reveals the CNS and Kidneys.
increased titers to Proteus OXK antigens (up to TYPES OF LEPTOSPIROSIS
1:80)
ICTERIC LEPTOSPIROSIS OR WEIL
• Lyme disease: Serology is the standard method
SYNDROME
for the diagnostic testing of this disease.
• IGM and IGG antibodies are detected in the • Severe form of illness that affects the liver and
serum. kidneys and causes vascular dysfunction
• Serology: ELISA and IFA (Indirect • Death up to 10% of the cases
Immunofluorescent Assay) • Icteric – jaundice/yellowish discoloration
MOLECULAR TESTS (paninilaw)
ANICTERIC LEPTOSPIROSIS
• PCR is important in diagnosis of B. burgdorferi
DNA in urine. • Symptoms: Septicemic stage of infection, high
LEPTOSPIRA fever and severe headache (3 to 7 days)
• Leptospira interrogans (pathogenic species, followed by the immune stage
looks like a question mark)) and Leptospira • Hallmark of immune stage: Aseptic meningitis.
biflexa (non-pathogenic species) • Absence of yellowish discoloration of the skin
• Leptospira interrogans LABORATORY DIAGNOSIS
serotype • Specimen: Blood, CSF and tissues for the
bacterimic phase (first week); urine for the
immune phase (second week)
• Microscopic Examination
• Darkfield microscopy, can be used for the
detection of motile leptospires in the specimens.
• Culture
GENERAL CHARACTERISTICS OF o Culture media: Fletcher’s medium,
LEPTOSPIRA Ellinghausen-McCullough-Johnson-
• Genus belongs to the family Leptospiraceae Harris (EMJH) medium, Bovine serum
under the order of Spirochaetales. albumin, Stuart’s broth and Noguchi’s
• Species of this genus are obligate aerobes medium
which can be grown in artificial media. o Fletcher’s and EMJH media are semi-
• They are tightly coiled and are highly motile with solid media.
hooked ends. (looks like a question mark) • Serodiagnosis
• They live in the lumen of the renal tubules and o Commonly used methods for antigen
shed into the urine detection: ELISA, Radio immunoassay
(RIA) and immunomagnetic capturing
• Recommended animals for cultivation:
o Antigen detection:
Hamsters and guinea pigs
Immunofluorescence and
• Microscopy: Tightly coiled, Thin, flexible
immunohistochemistry
organisms with two long axial filaments that
o Reference method: microscopic
exhibit a spinning motility.
agglutination (MA) using living cells
• Virulence factor: Hemolysin (L. interrogans)
• Molecular Test
• Growth factor: Hemoglobin and thiamine o Detects leptospiral DNA in infected
• Animal Reservoir: Rats and Dogs patients
LEPTOSPIRA SPP. o Methods: Polymerase chain reaction
LEPTOSPIROSIS OR INFECTIOUS JAUNDICE and hybridization techniques.
• Zoonotic disease in humans caused by MISCELLANEOUS BACTERIA
Leptospira interrogans • Streptobacillus moniliformis
• Acquired in home and recreational settings • Spirillum minus/minor
(swimming pools) • Klebsiella granulomatis
• Symptoms: Fever, headache, myalgia, anorexia • Capnocytophaga
and vomiting. • Enterococci
• MOA: • Gardenella

TUAZON A. 49
 STREPTOBACILLUS MONILIFORMIS arthralgia; and lymphadenitis;
• Etiologic agent: Rat-bite fever and Haverhill recurrent fever if and recurrent
fever in humans untreated fever if untreated
• Gram-negative bacillus Diagnosis Culture and Dark group
• Normally found in oropharynx of wild and serology microscopy,
laboratory rats microscopy of
• Facultatively anaerobic Giemsa-stained
• Non-motile, non-encapsulated and non- blood smear,
haemolytic and animal
• Diene’s stain: required to demonstrate the L- inoculation
form colonies Penicillin (L
• Microscopy: Yeast-like shape, Chains of bacilli forms not
Penicillin: in case
sensitive to
• Broth: fluff or breadcrumbs appearance Antibiotic of endocarditis,
penicillin). Both
• BAP: Fried-egg appearance with dark center therapy addition of an
forms sensitive
SPIRILLUM MINUS/MINO aminoglycoside
to streptomycin
• Rat-bite fever known as sodoku in humans and tetracycline
• Grow non artificial culture media Mortality Higher if Lower if
• Strictly aerobic, closely related Neisseria untreated (10%) untreated (6%)
• Direct visualization of specimen (blood, CAPNOCYTOPHAGA
exudates or lymph node tissue) using Giemsa • GNR with long fusiform shape.
stain, Wright stain or darkfield microscopy is
• Fastidious facultative anaerobe that grows
recommended.
slowly and needs enriched agar.
• Microscopy: Thick, helical, gram-negative
• C. animorsus
bacilli with 2 to 3 coils and are motile by
o Most common cause of severe disease
polytrichous polar flagella.
in humans.
KLEBSIELLA GRANULOMATIS o Normal flora in oral cavity of dogs (and
• Formerly known as Calymmatobacterium cats)
granulomatis • Classic clinical scenario:
• Etiologic agent: Granuloma inguinal or o Septic shock with fever, rash,
donovanosis: Sexually transmitted disease hypotension, renal failure → can evolve
nodule enlarged with beefy, erythematous, to purpura fulminans or gangrene.
granulomatous and painless lesion that easily • Risk factor for severe disease
bleed. o Contacts with clog (bite/scratch),
• Culture: Yolk sac or fresh egg yolk medium. immunocompromised host, asplenia,
• Microscopy: Blue rods with “safety pin” app and cirrhosis.
is surrounded by a pink capsule, presence DONOVAN BODIES
Donovan bodies in mononucleated endothelial
cells.
CAPNOCYTOPHAGA
• Indigenous microbiota of the oral cavity of
humans and animals (dog and cats)
• Resembles HACEK group in their CO2
requirements for enhanced growth
• Gliding motility on solid surface
• Facultatively anaerobic with a negative reaction
to most biochemical tests
• Microscopy: Gram-negative rods to filamentous
or spindle-shaped bacteria
• Culture: BAP or CAP: slight yellow or orange DONOVANOSIS
pigmentation.
COMPARISON OF RAT-BITE FEVER CAUSED BY
STREPTOBACILLUS AND SPIRILLUM SPECIES
Streptobacillus
Spirillum minus
moniliformis
Incubation Short (10 days) Long (15 days)
period
High fever, Fever,
headache, chills, headache, chills,
Symptoms
myalgia, rash, rash,
arthritis, lymphangitis,

TUAZON A. 50
ENTEROCOCCI (GROUP D STREPTOCOCCI)
• Specie: Enterococcus faecalis, Enterococcus
faecium, Enterococcus avium, Enterococcus
gallinarum, Enterococcus durans, Enterococcus
raffinosus
ENTEROCOCCUS SPP.
• Belong to family Streptococcaceae
• Produce D antigen
• Indigenous microbiota of human and animals’
intestinal tracts
• Not highly pathogenic but are frequent causes of
nosocomial infections
• Resistant to multiple antimicrobial agents
• Most common isolates: E. faecalis
• Virulence factor: Extracellular serine protease,
gelatinase and cytolysin
• Related infections: UTI, endocarditis,
bacteremia, wound infections
• Non-haemolytic or maybe alpha or beta
haemolytic
• Laboratory test: (+) Bile esculin and PYR; (+)
growth in 6.5% Nacl (Halophilic)
GARDENELLA VAGINALIS
• Gram-variable
• Coccobacillus
• Low numbers in normal vaginal flora
o Mostly lactobacilli
o Keep vaginal pH <4.5
• Whiff Test or KOH Test
o Specimen: Vaginal secretions
o Reagent: 10% KOH
o (+) Result: Exhibits “fishy amine
odor
o Also look for clue cells

GOODLUCK!

- aly

TUAZON A. 51